Lower extremity fractures after spinal cord injury (SCI) are more common in paraplegic than in quadriplegic persons, probably due to their greater activity level. Most of the fractures are pathologic in osteoporotic bones and most occur without known trauma or are caused by trivial injury. Supracondylar or shaft fractures of the femur are most common. Although callus formation is usually fast, exuberant fracture healing may be delayed. The main management goal, maintenance of functional independence without complications of SCI, is best obtained by a nonsurgical approach with traction or well-padded cast followed by early joint mobilization.